Efficacy of an assisted low‐intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial

Abstract

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Peri‐operative pelvic floor muscle training reduces urinary incontinence for men undergoing radical prostatectomy (RP). A preoperative biofeedback session, combined with postoperative pelvic floor muscle training, and assisted sessions on a monthly basis only, is an effective low‐intensity programme to improve recovery of continence in patients undergoing RP. OBJECTIVE To evaluate the efficacy of preoperative biofeedback (BFB) combined with an assisted low‐intensity programme of postoperative perineal physiokinesitherapy in reducing the incidence, duration and severity of urinary incontinence (UI) in patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS A prospective, single‐centre, randomized controlled clinical study was designed. The intervention group received a training session with BFB, supervised oral and written instructions on Kegel exercises and a structured programme of postoperative exercises on the day before open RP. After RP, patients received control visits, including a session of BFB, at monthly intervals only. The control group received, after catheter removal, only oral and written instructions on Kegel exercises to be performed at home. Patients received control visits at 1, 3 and 6 months after catheter removal. At each visit the number of incontinence episodes, the number of pads used and patient‐reported outcome measures (International Consultation on Incontinence Questionnaire on Urinary Incontinence [ICIQ‐UI], [ICIQ]‐Overactive Bladder [OAB], University of California, Los Angeles‐Prostate Cancer Index [UCLA‐PCI], International Prostate Symptom Score‐Quality of Life [IPSS‐QoL]) were assessed in both groups. All patients were followed‐up for a period of at least 6 months after catheter removal. The primary outcome was the recovery of continence, strictly defined as a ICIQ‐UI score of zero. RESULTS Overall, 34 consecutive patients were eligible and 32 were available for the final analysis: 16 patients for each study group. The two groups were homogeneous for all pre‐ and intraoperative features examined. In the intervention group, continence had been achieved by six, eight and 10 patients at 1‐, 3‐ and 6‐month follow‐ups, respectively, vs no patients (P= 0.02), one patient (P= 0.01) and one patient (P= 0.002) in the control group at each follow‐up, respectively. The analysis of the UCLA‐PCI and ICIQ‐OAB scores, the number of incontinence episodes per week and the number of pads per week showed significant differences in favour of patients in the intervention group at 3 and 6 months. Patients in the intervention group reported better IPSS‐QoL scores at all follow‐up times but the difference did not reach statistical significance. CONCLUSIONS Preoperative BFB combined with a postoperative programme of perineal physiokinesitherapy and assisted sessions on a monthly basis only, is a treatment strategy significantly more effective than the standard care in improving reco...

Integrative review on the non‐invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies

“…In one trial, a single session of biofeedback‐assisted behavioural training reduced the duration of UI as well as the severity of symptoms in the 6 months post‐RP 22. In post‐RP patients, intense preoperative biofeedback‐assisted PFMT session which given one day before RP, – session immediately following catheter removal – and then monthly, combined with an assisted, low‐intensity postoperative programme has demonstrated reductions in the duration and severity of UI as well as improvements in QoL 87.…”

“…In the standing position PFMs should be conducted with feet apart; and in the sitting position, PFMs should be conducted with the knees apart. Evidence suggests it is the intensity rather than the frequency of the PFMs that is important 87, 111. …”

“…PFMT structured home programme: 10 min each day of 5‐s muscle contractions with 5‐s muscle relaxation performed in three different positions 87: The protocol consists of 5 slow exercises i.e. to hold and count to 10 and then 5 fast exercises, which are useful for urge incontinence.…”

The Effect of Telephone-enforced Pelvic Floor Muscle Exercise on Incontinence, Urinary Function Related Satisfaction, Depression, and Quality of Life for Prostate Cancer Patients

“…여 요실금 감소에 효과적이다 [10,11]. 또한 골반저 근육운동 은 빈도와 강도에 따라 근육이 강화되는 정도가 달라지기 때 문에 정확한 방법으로 지속성을 유지하는 것이 중요하다 [12].…”

In incontinence developing after radical prostatectomy the role of nurses on implementing behavioral therapy

“…The literature emphasizes that behavioral therapy has positive and highlighted effect on this problem (Ballet et al 2000, Filocamo et al 2005, MacDonald et al 2007, Overgård et al 2008, Ribeiro et al 2010, Tienforti et al 2012, Lombraña et al 2013). …”